Scaling up maternal and child health interventions in low and middle income countries

Health workers explain how they expanded access to postpartum family planning in India. Photo: iMaCS

The USAID funded Maternal and Child Health Integrated Program (MCHIP) increased access to health promoting and life-saving interventions in over 50 countries between 2008 and 2014.

A program of this size offers a unique opportunity for learning lessons about what strategies work to scale up health interventions, how they work and under what circumstances.

This project consisted of two complementary activities.

The first activity was a description of 18 cases of efforts to scale up potentially high-impact health innovations. The review used the ExpandNet framework to compare core elements and strategies. Outcome variables were changes in the coverage of the intervention (expansion to new geographic areas or facilities and increased utilization rates) and institutionalization of the intervention within government health systems. The review found that there was no single strategy which could assure the intervention would be successfully taken to scale. However, the more successful scale-up efforts went beyond addressing national policy by working closer to the ground: supporting quality service delivery; encouraging community members and beneficiaries to demand services; and, continuously monitoring activities and taking action if there were problems. The full report can be accessed from the link in the box in the upper right-hand corner.

The second activity was in-depth case studies to investigate how scale-up efforts led to change throughout the health system, from national policy setting to the actions of front-line workers and community members. The case studies were of the introduction of postpartum family planning counselling and services in public hospitals in India and treatment of life-threatening childhood diseases by community health workers in Mali. Also included in the synthesis was results of several process and effectiveness evaluations of the scale ups of a newborn resuscitation approach conducted in Bangladesh and Malawi. The analysis argues that scale-up efforts are most effective if they can navigate the challenges inherent in changing complex adaptive systems: multiple context-dependent, interacting components and feedback loops which can result in unpredictable responses to the introduction of the intervention. The link to that report is also in the upper right-hand corner.

Ann Larson was contracted through John Snow Inc for this project and work closely with JSI staff Jessica Posner, Anne LaFond and Natasha Kanagat.

In India Ann loved working with a resourceful team from iMaCS lead by Dr Rajesh Khanna and Prakash Philip. In Mali, Ann would have been lost without the support of Dr Mamadou Kani Konaté and his team at Marikani.